Spotlight shines on care home quality and safety assurances

A new ‘Spotlight’ has been shone on the way the NHS monitors quality and safety for patients in NHS-funded care home beds in Stoke-on-Trent and Staffordshire.

A two-page Spotlight document published on the Stoke-on-Trent and North Staffordshire Clinical Commissioning Group (CCG) websites reveals the steps that are taken to ensure patients in NHS-commissioned beds in care homes receive a similar quality of care as patients would expect in an NHS-run hospital.

When developing the proposals for the future of local health services, concerns have been raised by members of the public about the quality of care provided in NHS-commissioned beds in care homes to meet the health and care needs of local people after a stay in hospital while they undergo rehabilitation and assessment for their future care needs.

“Our primary concern is the safety and welfare of patients,” said Heather Johnstone, Director of Nursing and Quality for the area’s CCGs.

“Patients who are medically fit to be discharged from hospital should not be stranded in a hospital bed. It can lead to physical and mental deterioration which is known as Deconditioning Syndrome where patients lose physical strength and self-confidence. It is not in their best interests to be in hospital for a long period of time if they don’t need to be there.

“Ideally patients should go home as soon as they are medically fit for discharge and have their care needs assessed there. But some need extra help and support while their needs are assessed and therefore spend some time in a registered care home, funded by the NHS.

“We have put in place several processes and measures to make sure that patients in the NHS beds are carefully monitored and their needs regularly reviewed and reassessed and are meeting patients’ needs, which are over and above CQC inspections. All care homes used in this scheme are registered with the Care Quality Commission (CQC) who regulate care standards, and the CCG only commission those providing a good standard of care. In addition to the regulatory inspections, care homes are inspected by the Local Authority Quality Assurance Team in collaboration with CCG Nurses and Healthwatch.”

Some care home inspection facts:

All care homes are inspected by the Care Quality Commission (CQC)

All care homes that have any residents who are paid for by the NHS are inspected by nurse-led NHS Quality Teams

Local authorities (councils) have Safeguarding and Quality Teams who undertake monitoring visits

Healthwatch volunteers also make unannounced visits.

Increasingly, new initiatives mean there is increased support for care homes. All care homes are registered with a GP practice so their residents receive the same primary care services as they would if they lived in their own home. GP practices are using new technology directly linking the homes with practices using portable computer tablets loaded with audio visual programmes, the locally-developed Florence telehealth system, health management apps and video consultation technology. This links the homes and their residents with an extended network of primary care, mental health and palliative care staff, community pharmacists and geriatricians.

The CCGs are working with both Staffordshire and Stoke-on-Trent local authorities to implement a Care Home Turnaround Team to support homes with training and quality standards across the board and to improve overarching standards of care.

The CCGs have also commissioned a Care Home Wraparound Team via the three Alliance Boards in the north, south east and south west of Staffordshire and Stoke-on-Trent working with GPs, NHS providers, the local authorities and local hospices. The team supports a reduction in non-elective admissions to hospitals for care home residents through regular, proactive review and the implementation of advanced care plans for all care home residents.

It is also increasingly common for Advanced Nurse Practitioners to visit care homes, both to support residents and provide help and advice to staff.

Heather Johnstone added: “Even if just a single bed is being commissioned by the NHS, the home is subject to inspection.

“The CQC, local authority and NHS teams inspect everything including the physical environment, quality of leadership, the training of the staff and whether any residents arriving from hospital are accompanied with the correct information such as medicines or physiotherapy requirements.

“Care homes offer a more homely environment than a hospital. Residents generally have their own en-suite room, a TV, personal possessions, access to social events and there are no restricted visiting times. They are encouraged to get out of a bed and have a routine, just as they would at home.

“We’re hoping people will look at this newly published Spotlight to inform themselves about how care homes can form a valuable part of care provided to patients, and it will help stimulate conversation around this important subject.”

Marcus Warnes, Accountable Officer for the Staffordshire and Stoke-on-Trent CCGs said: “We commission a very small number of beds in a few carefully selected care homes for a period of up to six weeks following discharge from hospital. These beds are for patients with more complex conditions to be assessed for their long-term care needs.

“Unless someone qualifies for NHS Continuing Healthcare funding, the CCGs do not commission long-term care in care home beds. The CCGs are committed to ensuring that all beds commissioned in care homes for this purpose provide a high quality experience, with care equal to that they would expect to receive in an NHS hospital bed. Our Spotlight initiative will enable us to reassure this is the case.”